Managing alcohol abuse in a family context.

Treatment of alcohol abuse may be initiated by the person with the alcohol problem, the spouse or another family member. When the patient and the family confront the problem, established behavior patterns may be disrupted. Specific resources, such as Alcoholics Anonymous and Al-Anon, can help the family physician successfully manage substance abuse within a family context. Specific techniques and approaches directed at the patient, such as helping the patient acknowledge the problem, using the medical model to achieve a successful referral and challenging the patient to a four-week period of abstinence, are valuable tools for the family physician. Other techniques aimed at the spouse, such as enlisting the spouse's cooperation, using the spouse's energy and using the medical model to help the spouse and other family members obtain treatment, are also effective.     

Perspectives on surviving childhood sexual abuse

This paper begins by examining sexual victimization and professional 'thinking sets' in relation to abuse. It goes on to offer an exploration of the literature in the area of childhood sexual abuse and its survival, and attempts to marshal some of this literature into naturally occurring conceptual groups with connecting theoretical threads. A summary of the theoretical paradigms which seem to produce dominant perspectives on the area is made. A cautionary discussion is introduced regarding the deterministic nature of the influence of these perceptual viewpoints upon research and therapeutic activity. Implications for nursing practice and education are drawn.     

Understanding the need for personal space boundary restoration in women-client survivors of intrafamilial childhood sexual abuse

A large volume of literature exists on childhood sexual abuse (CSA) and nursing literature on this topic continues to develop. However, discussion of boundaries in relation to intrafamilial childhood sexual abuse (ICSA) and to its significance in terms of personal space boundary (PSB) violation, is lacking. This is important, as PSB violation creates difficulties for adult survivors of ICSA and for nurses who care for these people as clients. As all experiences of CSA cannot be addressed, discussion focuses on women who are clients of mental health services and who have experienced ICSA. Using Scott's work on boundaries and her diagrammatic conceptualization of PSBs, links are created between ICSA boundary violation, resultant PSB regulation difficulties and principles to guide nursing practice. Discussion centres on understanding the need for PSB restoration in women-client survivors of ICSA.     

Health risk behaviors and medical sequelae of childhood sexual abuse.

The relationship between childhood sexual abuse and subsequent health risk behaviors and medical problems was examined in 511 women who had used a family practice clinic in a rural midwestern community during a 2-year period (1988 and 1989). These women completed a questionnaire that assessed various health risk behaviors--smoking, drinking, drug abuse, number of sexual partners, and age at first intercourse--and a medical symptom checklist that assessed 38 medical problems related to major systems of body function, the somatization scale from the SCL-90, a screen for sexual abuse, and a brief measure of social support. The results indicated that sexually abused women, who represented 22.1% of the sample, reported significantly more medical problems, greater levels of somatization, and more health risk behaviors than did the nonabused women. More severe abuse (for example, penetration or multiple abusers) correlated with more severe problems. Extent of social support correlated inversely with the number of gynecologic problems reported in the sexually abused group. Fewer than 2% of the sexually abused women had discussed the abuse with a physician. To identify and assist victims of sexual abuse, physicians should become experienced with nonthreatening methods of eliciting such information when the medical history is obtained.     

Long-term consequences of childhood physical and sexual abuse

Psychiatric nurses are confronted daily with individuals who are suffering from the consequences of trauma. Physical and sexual abuse is associated with acute psychiatric symptomatology in children and may progress to a spectrum of psychiatric and medical disorders in adults, ranging from the extreme adaptive reactions seen in multiple personality disorder and refractory psychosis to intermediate adaptive reactions present in borderline personality disorder to more delimited reactions manifest in chronic headaches and unremitting pelvic pain. Subjects sampled in inpatient, outpatient, psychiatric, medical, criminal, and community settings describe the link between histories of widespread abuse and various intractable and common disorders. This article presents the state-of-the-are knowledge of the long-term sequelae of childhood physical and sexual abuse by critically reviewing the initial uncontrolled investigations and mounting evidence from controlled studies.     

Understanding elder abuse in family practice

Objective

To discuss what constitutes elder abuse, why family physicians should be aware of it, what signs and symptoms might suggest mistreatment of older adults, how the Elder Abuse Suspicion Index might help in identification of abuse, and what options exist for responding to suspicions of abuse.

Sources of information

MEDLINE, PsycINFO, and Social Work Abstracts were searched for publications in English or French, from 1970 to 2011, using the terms elder abuse, elder neglect, elder mistreatment, seniors, older adults, violence, identification, detection tools, and signs and symptoms. Relevant publications were reviewed.

Main message

Elder abuse is an important cause of morbidity and mortality in older adults. While family physicians are well placed to identify mistreatment of seniors, their actual rates of reporting abuse are lower than those in other professions. This might be improved by an understanding of the range of acts that constitute elder abuse and what signs and symptoms seen in the office might suggest abuse. Detection might be enhanced by use of a short validated tool, such as the Elder Abuse Suspicion Index.

Conclusion

Family physicians can play a larger role in identifying possible elder abuse. Once suspicion of abuse is raised, most communities have social service or law enforcement providers available to do additional assessments and interventions.     

Homeopathy in survivors of childhood sexual abuse

The objective of this review was to ascertain the incidence of childhood sexual abuse: to ascertain the long-term effects of childhood sexual abuse and to collate the experiences of homeopaths in caring for survivors. Childhood sexual abuse (CSA) is common with a high percentage of homeopathic patients giving a positive history. It is associated with many common clinical conditions, particularly pelvic pain. Survivors are more likely to present for medical help and to be hospitalised. Homeopaths have found work with such patients to be difficult, with cases being complex and multi-layered. New models for case-analysis have been developed.     

Experiences of women healing from childhood sexual abuse

Childhood sexual abuse has affected the lives of countless survivors who seek help within the health care system. Despite extensive research and clinical work, many survivors do not receive adequate help. This research aimed to add to the body of clinical knowledge by reporting on the experiences of childhood sexual abuse survivors who have achieved a measure of healing. Findings from a naturalistic study of 14 female survivors of childhood sexual abuse are presented. The character of healing, the relationship of context with healing, what facilitated healing, and what impeded healing are discussed.     

Repeat deliberate self-harm: a link with childhood sexual abuse?

The purpose of this study was to identify whether a past history of childhood sexual abuse is a risk factor for repeated Deliberate Self-Harm (DSH). The study was a 6-month prospective study of 178 patients responsible for 190 consecutive cases of DSH seen during a 3-month censoring period. Patients were identified by review of the in-patient and accident and emergency (A&E) records of all cases of DSH at the A&E department of a major teaching hospital. Patients with a history of childhood sexual abuse showed a marked clustering of four major risk factors for repeat DSH (unemployment, past deliberate self-poisoning, self-injury and psychiatric illness) and were significantly more likely to repeat DSH within the 6-month follow-up period.     

A comparative study among college students of sexual abuse in childhood.

A disproportionate random sample (200 women, 400 men) of students attending a major university was invited to participate in a mailed survey to study differences in self-efficacy, coping, and well-being between men and women who were sexually abused in childhood and those who were not. A total of 271 students (111 women, 160 men) responded by returning the completed survey. Fifty percent of the women and 22% of the men in the sample reported one or more unwanted sexual experiences in childhood. Multivariate analysis of variance (MANOVA) techniques to analyze differences in self-efficacy, coping (confrontive, emotive, palliative), and well-being between women and men who reported childhood sexual abuse and those who did not showed significant interaction effects by sex for abuse (F = 2.609, P = .025, df 5,263) and significant effects by sex (F = 3.356, P = .006), but no significant differences for abuse alone. Univariate F tests were significant (F = 5.386, P = .021) for palliative coping with abused men reporting the highest scores, abused and nonabused women having the highest scores on emotive coping (F = 9.049, P = .003), and nonabused men and women having highest scores on well-being (F = 7.276, P = .007). A second MANOVA was performed on data from 245 students (nonabused and those who reported contact sexual abuse). Significant interaction effects by sex for abuse (F = 2.259, P = 0.49, df 5,237) and main effects for abuse (F = 3.225, P = .008) were found. Although abused men scored lowest on well-being, both abused men and abused women scored higher on emotive coping and lower on well-being than nonabused subjects. These are new findings with implications for developing and testing nursing interventions for this vulnerable group of young adults.     

Overcoming sequelae of childhood sexual abuse with stress management

The immense stress associated with experiencing and surviving childhood sexual abuse directly influences coping, immune function and overall health. Lifelong overuse of maladaptive coping strategies results in impaired adjustment to stress. The purpose of this research was to re-examine if stress management education would be effective in improving coping skills for this population. Two 4-week series of stress management workshops were completed by 32 adult survivors who completed the ways of coping questionnaire before and after the training. Four categories of coping showed significant change. Stress management education is an effective and cost-efficient approach that gives adult survivors an empowering set of tools for their healing journey.     

Models of response to childhood sexual abuse: their implications for treatment

Childhood sexual abuse (CSA) has been linked to adult mental health problems and indicators of severity of psychiatric illness. There exist large, unexplained individual differences in the presentation of mental health problems following CSA. Complex statistical methodologies allow researchers to examine models of response to CSA and its impact on mental health. Two early models are presented and critiqued. Two more recent models are then presented. It is concluded that whereas no single variable can, on its own, account for individual variation in symptom development, empirically tested models point toward a complex interaction between abuse-related factors, interactions with others (e.g., responses to disclosure, attachment), and individual factors (e.g., attributions, emotion-focused coping) as mediators and moderators of outcome. The implications of increased understanding of the complex interaction of these factors in understanding clinical presentations and in the formulation of treatment plans are explored.